Objective:To compare the clinical outcomes of thoracic endovascular aortic repair (TEVAR) using self-radiopaque marker guided physician modified fenestration with stent-graft in situ fenestration technology with or without the implantation of branch stents for the treatment of aortic arch diseases.Methods:The clinical data of 653 patients with aortic arch diseases who underwent TEVAR using fenestration from Dec 2015 to Jun 2023 at two vascular surgery centers were retrospectively analyzed.Results:A total of 454 patients received branch stent implantation, while 199 did not. The incidence of non-aortic-related complications within 30 days post-operation was higher in the branch stent implantation group compared to the non-implantation group (8.6% vs. 3.5%, P=0.020). The overall follow-up rate was 93.8%, with median follow-up time of 37 months and 52 months for the branch stent implantation group and non-implantation group, respectively. Kaplan-Meier survival analysis showed no significant statistical difference between the two groups in terms of cumulative all-cause survival ( P=0.223), free from endoleak ( P=0.106), and free from branch artery occlusion ( P=0.130). Conclusions:The implantation of branch stents following in situ fenestration with stent-graft technology in TEVAR did not significantly affect overall survival, endoleak incidence, or branch artery occlusion rates in patients with aortic arch diseases. Therefore, the decision to implant branch stents should be tailored according to the specific pathology and anatomical characteristics of the aortic arch.

Objectives:To evaluate the safety and feasibility of endovascular aortic repair without contrast agent under branch artery guidewire marking(FLARE technique).Methods:The clinical data of 7 patients who underwent contrast-free endovascular aortic repair with branch artery guidewire marking in Fuwai Hospital from 2024 to 2025 were retrospectively analyzed.The criteria for patient selection included renal insufficiency,history of contrast agent allergy,high risk of high-pressure angiography due to extensive calcification of the aortic arch,and patients'strong personal wishes,all patients merited with anatomically friendly and anchored area criteria.The patients were evaluated by preoperative computed tomography or color Doppler ultrasound,and the occlusive stent anchor point was located by branch artery guidewire marking combined with bone marking during surgery.The primary endpoints were early stage of postoperative renal function changes(comparison of preoperative and postoperative serum creatinine)and surgical technique success rate,and the secondary endpoints included the incidence of internal leakage,re-intervention rates,and incidence of aneurysm and kidney-related adverse events during follow-up.Results:Among the seven patients who underwent endovascular aortic repair without contrast using a branch artery guidewire,four were male,with an average age of(72.0±5.9)years.Six of these patients had infrarenal abdominal aortic aneurysms,two of them with bilateral renal artery severe stenosis and renal insufficiency underwent renal artery stenting combined with endovascular aortic repair,one patient had isolated chronic renal insufficiency,one had a history of iodine contrast skin allergy,and the remaining two cases wished this surgery option.The seventh patient had a penetrating ulcer in the aortic arch and descending aorta,along with extensive thrombosis and calcification in the ascending aorta,aortic arch and descending aorta.All the patients achieved surgical technique success.No iodine contrast agent was used during the procedure for endovascular aortic repair.In patients with chronic renal insufficiency and renal artery stenosis before surgery,serum creatinine levels were significantly improved after surgery.All patients did not need hemodialysis,there was no allergic reaction,and no graft-related or perioperative complications.The average follow-up was(5.8±3.0)months,all patients recovered well without re-intervention or complications.The creatinine levels did not fluctuate significantly after surgery.Conclusions:Branch artery guidewire marked contrast-free aortic endovascular repair may be a safe and feasible treatment option in selected patients,especially in patients with contraindications to contrast agents.

A 14-year-old boy was admitted to the hospital due to a single episode of afebrile seizure and four hours of impaired consciousness. Three months prior to admission, he had a history of bilateral uveitis. Cerebrospinal fluid analysis revealed a mild elevation in white blood cell count. Cranial magnetic resonance imaging and contrast-enhanced scans showed multiple abnormal signals in both cerebral hemispheres, with punctate and nodular enhancement. Susceptibility-weighted imaging revealed multiple punctate hemorrhages within lesions in the bilateral frontal and left parietal lobes, suggestive of vasculitis. Brain biopsy demonstrated inflammatory granulomatous lesions. No secondary causes were identified, and the final diagnosis was granulomatous primary central nervous system vasculitis. The patient's condition improved after treatment with methylprednisolone sodium succinate and mycophenolate mofetil. This report describes a rare case of granulomatous central nervous system vasculitis in a child and provides valuable insights for the diagnosis and treatment of this disease.
Humans ; Male ; Vasculitis, Central Nervous System/diagnosis* ; Adolescent ; Magnetic Resonance Imaging ; Granuloma/diagnosis*

OBJECTIVE: To retrospectively analyze the clinical characteristics, co-mutated genes in newly diagnosed acute myeloid leukemia (AML) patients with NRAS and KRAS gene mutations, and the impact of NRAS and KRAS mutations on prognosis. METHODS: The clinical data and next-generation sequencing results of 80 newly diagnosed AML patients treated at our hospital from December 2018 to December 2023 were collected. The clinical characteristics, co-mutated genes of NRAS and KRAS , and the impact of NRAS and KRAS mutations on prognosis in newly diagnosed AML patients were analyzed. RESULTS: Among 80 newly diagnosed AML patients, NRAS mutations were detected in 20 cases(25.0%), and KRAS mutations were detected in 9 cases(11.3%). NRAS mutations predominantly occurred at codons 12 and 13 of exon 2, as well as codon 61 of exon 3, while KRAS mutations were most commonly occurred at codons 12 and 13 of exon 2, all of which were missense mutations. There were no statistically significant differences observed in terms of age, sex, white blood cell count(WBC), hemoglobin(Hb), platelet count(PLT), bone marrow blasts, first induction chemotherapy regimen, CR1/CRi1 rates, chromosome karyotype, 2022 ELN risk classification and allogeneic hematopoietic stem cell transplantation(allo-HSCT) among the NRAS mutation group, KRAS mutation group and NRAS/KRAS wild-type group (P >0.05). KRAS mutations were significantly correlated with PTPN11 mutations (r =0.344), whereas no genes significantly associated with NRAS mutations were found. Survival analysis showed that compared to the NRAS/KRAS wild-type group, patients with NRAS mutation had a relatively higher 5-year overall survival (OS) rate and relapse-free survival (RFS) rate, though the differences were not statistically significant (P =0.097, P =0.249). Compared to the NRAS/KRAS wild-type group, patients with KRAS mutation had a lower 5-year OS rate and RFS rate, with no significant differences observed (P =0.275, P =0.442). There was no significant difference in the 5-year RFS rate between the KRAS mutation group and NRAS mutation group (P =0.157), but the 5-year OS rate of patients with KRAS mutation was significantly lower than that of patients with NRAS mutation (P =0.037). CONCLUSION In newly diagnosed AML patients, KRAS mutation was significantly correlated with PTPN11 mutation. Compared to patients with NRAS/KRAS wild-type, those with NRAS mutation showed a more favorable prognosis, while patients with KRAS mutation showed a poorer prognosis; however, these differences did not reach statistical significance. Notably, the prognosis of AML patients with KRAS mutation was significantly inferior compared to those with NRAS mutation.
Humans ; Leukemia, Myeloid, Acute/diagnosis* ; Mutation ; Prognosis ; Proto-Oncogene Proteins p21(ras)/genetics* ; GTP Phosphohydrolases/genetics* ; Retrospective Studies ; Membrane Proteins/genetics* ; Female ; Male ; Middle Aged ; Adult ; Aged

Objectives:To evaluate the safety and feasibility of endovascular aortic repair without contrast agent under branch artery guidewire marking(FLARE technique).Methods:The clinical data of 7 patients who underwent contrast-free endovascular aortic repair with branch artery guidewire marking in Fuwai Hospital from 2024 to 2025 were retrospectively analyzed.The criteria for patient selection included renal insufficiency,history of contrast agent allergy,high risk of high-pressure angiography due to extensive calcification of the aortic arch,and patients'strong personal wishes,all patients merited with anatomically friendly and anchored area criteria.The patients were evaluated by preoperative computed tomography or color Doppler ultrasound,and the occlusive stent anchor point was located by branch artery guidewire marking combined with bone marking during surgery.The primary endpoints were early stage of postoperative renal function changes(comparison of preoperative and postoperative serum creatinine)and surgical technique success rate,and the secondary endpoints included the incidence of internal leakage,re-intervention rates,and incidence of aneurysm and kidney-related adverse events during follow-up.Results:Among the seven patients who underwent endovascular aortic repair without contrast using a branch artery guidewire,four were male,with an average age of(72.0±5.9)years.Six of these patients had infrarenal abdominal aortic aneurysms,two of them with bilateral renal artery severe stenosis and renal insufficiency underwent renal artery stenting combined with endovascular aortic repair,one patient had isolated chronic renal insufficiency,one had a history of iodine contrast skin allergy,and the remaining two cases wished this surgery option.The seventh patient had a penetrating ulcer in the aortic arch and descending aorta,along with extensive thrombosis and calcification in the ascending aorta,aortic arch and descending aorta.All the patients achieved surgical technique success.No iodine contrast agent was used during the procedure for endovascular aortic repair.In patients with chronic renal insufficiency and renal artery stenosis before surgery,serum creatinine levels were significantly improved after surgery.All patients did not need hemodialysis,there was no allergic reaction,and no graft-related or perioperative complications.The average follow-up was(5.8±3.0)months,all patients recovered well without re-intervention or complications.The creatinine levels did not fluctuate significantly after surgery.Conclusions:Branch artery guidewire marked contrast-free aortic endovascular repair may be a safe and feasible treatment option in selected patients,especially in patients with contraindications to contrast agents.

Objective:To compare the clinical outcomes of thoracic endovascular aortic repair (TEVAR) using self-radiopaque marker guided physician modified fenestration with stent-graft in situ fenestration technology with or without the implantation of branch stents for the treatment of aortic arch diseases.Methods:The clinical data of 653 patients with aortic arch diseases who underwent TEVAR using fenestration from Dec 2015 to Jun 2023 at two vascular surgery centers were retrospectively analyzed.Results:A total of 454 patients received branch stent implantation, while 199 did not. The incidence of non-aortic-related complications within 30 days post-operation was higher in the branch stent implantation group compared to the non-implantation group (8.6% vs. 3.5%, P=0.020). The overall follow-up rate was 93.8%, with median follow-up time of 37 months and 52 months for the branch stent implantation group and non-implantation group, respectively. Kaplan-Meier survival analysis showed no significant statistical difference between the two groups in terms of cumulative all-cause survival ( P=0.223), free from endoleak ( P=0.106), and free from branch artery occlusion ( P=0.130). Conclusions:The implantation of branch stents following in situ fenestration with stent-graft technology in TEVAR did not significantly affect overall survival, endoleak incidence, or branch artery occlusion rates in patients with aortic arch diseases. Therefore, the decision to implant branch stents should be tailored according to the specific pathology and anatomical characteristics of the aortic arch.

Objective To observe the efficacy and safety of Morinda officinalis oligosaccharides in the continuation treatment of mild and moderate depression.Methods An open,single-arm,multi-center design was adopted in our study.Adult patients with mild and moderate depression who had received acute treatment of Morinda officinalis oligosaccharides were enrolled and continue to receive Morinda officinalis oligosaccharides capsules for 24 weeks,the dose remained unchanged during continuation treatment.The remission rate,recurrence rate,recurrence time,and the change from baseline to endpoint of Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Clinical Global Impression-Severity(CGI-S)and Arizona Sexual Experience Scale(ASEX)were evaluated.The incidence of treatment-related adverse events was reported.Results The scores of HAMD-17 at baseline and after treatment were 6.60±1.87 and 5.85±4.18,scores of HAMA were 6.36±3.02 and 4.93±3.09,scores of CGI-S were 1.49±0.56 and 1.29±0.81,scores of ASEX were 15.92±4.72 and 15.57±5.26,with significant difference(P＜0.05).After continuation treatment,the remission rate was 54.59％(202 cases/370 cases),and the recurrence rate was 6.49％(24 cases/370 cases),the recurrence time was(64.67±42.47)days.The incidence of treatment-related adverse events was 15.35％(64 cases/417 cases).Conclusion Morinda officinalis oligosaccharides capsules can be effectively used for the continuation treatment of mild and moderate depression,and are well tolerated and safe.

Objective To investigate the attributable risk(AR)of Acinetobacter baumannii(AB)infection in criti-cally ill patients.Methods A multicenter retrospective cohort study was conducted among adult patients in inten-sive care unit(ICU).Patients with AB isolated from sterile body fluid and confirmed with AB infection in each cen-ter were selected as the infected group.According to the matching criteria that patients should be from the same pe-riod,in the same ICU,as well as with similar APACHE Ⅱ score(±5 points)and primary diagnosis,patients who did not infect with AB were selected as the non-infected group in a 1:2 ratio.The AR was calculated.Results The in-hospital mortality of patients with AB infection in sterile body fluid was 33.3％,and that of non-infected group was 23.1％,with no statistically significant difference between the two groups(P=0.069).The AR was 10.2％(95％CI:-2.3％-22.8％).There is no statistically significant difference in mortality between non-infected pa-tients and infected patients from whose blood,cerebrospinal fluid and other specimen sources AB were isolated(P＞0.05).After infected with AB,critically ill patients with the major diagnosis of pulmonary infection had the high-est AR.There was no statistically significant difference in mortality between patients in the infected and non-infec-ted groups(P＞0.05),or between other diagnostic classifications.Conclusion The prognosis of AB infection in critically ill patients is highly overestimated,but active healthcare-associated infection control for AB in the ICU should still be carried out.

Endovascular aneurysm repair (EVAR) is a key treatment for abdominal aortic aneurysms (AAA),but type Ⅱ endoleak (T2EL) is one of the most common postoperative complications. T2EL mainly arises from retrograde blood flow from collateral vessels such as the inferior mesenteric artery (IMA) and lumbar arteries (LA),which continue to perfuse the aneurysm sac. Although T2EL may lead to aneurysm sac enlargement or even rupture,its overall clinical impact is relatively minor,and most cases can be effectively managed through observation or minimally invasive interventions. Currently,the efficacy of prophylactic embolization of the IMA and LA in reducing the incidence of T2EL remains uncertain and may increase operative time,radiation exposure,and the risk of associated complications. More importantly,authoritative guidelines,both domestic and international,do not recommend routine prophylactic embolization of the IMA and LA during EVAR. Whether prophylactic embolization should be performed in high-risk patients for T2EL remains controversial,with most studies in this area being small-sample or single-center retrospective analyses,offering limited evidence quality. This article analyzes the harm of T2EL,the effectiveness of prophylactic embolization,and relevant guideline recommendations based on existing research,aiming to provide a reference for the individualized management of T2EL following EVAR.

Aim To investigate the effects of multi-gly-cosides of Tripterygium wilfordii(GTW)on mitochon-drial dynamics-related proteins and the mechanism of nephroprotective effects in IgA nephrophathy(IgAN)rats.Methods SPF grade male SD rats were random-ly divided into the Control group,modelling group,prednisone group(6.25 mg·kg·d-1)and GTW group(6.25 mg·kg·d-1).The IgAN rat model was established by the method of"bovine serum albumin(BSA)+carbon tetrachloride(CCl4)+lipopolysac-charide(LPS)".The total amount of urinary protein(24 h-UTP)and erythrocyte count in urine were meas-ured in 24 h urine.Blood biochemistry of serum albu-min(ALB),alanine aminotransferase(ALT),urea ni-trogen(BUN),and creatinine(Scr)were measured in abdominal aorta of the rats;immunofluorescence and HE staining were used to observe the histopathology of the kidneys;RT-PCR and Western blotting were used to detect the mRNA and protein expression levels of key proteins regulating mitochondrial division and fu-sion:dynamin-related protein 1(Drp1),mitochondrial fusion protein 1(Mfn1),and mitochondrial fusion pro-tein 2(Mfn2),and PTEN-induced putative kinase 1(Pink1),in the kidney tissue of rats.Results GTW significantly reduced urinary erythrocyte count and 24 h-UTP,decreased serum ALT,BUN and Scr levels,in-creased serum ALB levels,improved renal histopatho-logical status in IgAN rats,increased the protein and mRNA expression levels of Mfn1,Mfn2,and Pink1,and decreased the protein and mRNA expression levels of Drp1 in renal tissues.Conclusions GTW may regu-late mitochondrial structure and maintain the dynamic balance of mitochondrial dynamics by promoting the ex-pression of Mfn1,Mfn2,Pink1 and decreasing Drp1.This may result in a reduction in urinary erythrocyte counts and proteinuria,and an improvement in renal function.